This manual provides practical guidelines for the management of severely malnourished children. Addressed to doctors and other senior health workers, it explains what must be done to save lives, achieve successful management and rehabilitation, prevent relapse and promote full recovery. Throughout, the importance of treating severe malnutrition as both a medical and a social disorder is repeatedly emphasized. As successful management does not require sophisticated facilities and equipment or highly qualified personnel, the manual also performs a persuasive function, encouraging health professionals to do all they can to save these children and meet their great need for care and affection. Recommended procedures draw on extensive practical experience as well as several recent therapeutic advances. These include improved solutions of oral rehydration salts for the treatment of dehydration, better understanding of the role of micronutrients in dietary management, and growing evidence that physical and psychological stimulation can help prevent long-term consequences of impaired growth and psychological development.
Noting that the physiology of malnourished children is seriously abnormal, the manual gives particular attention to aspects of management - whether involving the interpretation of symptoms or the use of specific interventions - that differ considerably from standard procedures for well-nourished children. Details range from the reason why IV infusion easily causes overhydration and heart failure, through a list of treatments that have no value and should never be used, to the simple reminder that underarm temperature is not a reliable guide to body temperature in a malnourished child during rewarming. The manual opens with a concise introduction to the principles of management during three phases: initial treatment, rehabilitation, and follow-up. It then briefly discusses treatment facilities, explaining why hospital or other residential care is essential for treatment and when a child can be moved to a rehabiliation centre. The third chapter, on evaluation, provides advice on how to assess nutritional status, take a medical history, and conduct a physical examination.
Some laboratory tests are listed, although the book stresses that such tests are not needed to guide or monitor treatment. The most extensive chapter gives detailed guidelines for initial treatment. Separate sections are devoted to hypoglycaemia, hypothermia, dehydration and septic shock, dietary treatment, infections, vitamin deficiencies, very severe anaemia, congestive heart failure, and dermatosis of kwashiorkor. Information includes instructions for the preparation of formula diets from a few basic ingredients, and numerous tables and charts for determining the amount of feed to give, at which interval, to achieve an acceptable daily intake of calories. Subsequent chapters provide detailed guidelines for rehabiliation, including emotional and physical stimulation as well as feeding, for follow-up, and for managing cases that fail to respond to treatment. The manual concludes with brief advice on the management of severely malnourished children in disaster situations and refugee camps, and of severely malnourished adolescents and adults.
Appendices provide further practical guidance, such as sample recording forms, instructions for preparing feeds, and examples of easily constructed toys to aid in managing severe malnutrition in children.
